Measuring Geographic Access to Health Care in Rural Areas

Connor, Robert A.; Kralewski, John E.; Hillson, Steven D.

doi:10.1177/107755879405100304

Cited by 29 publications

(29 citation statements)

References 56 publications

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“…Unfortunately, supply ratios have some serious limitations. First, they do not account for patient border crossing, which commonly occurs for small geographies such as urban census tracts and postal code areas [49]. Second, supply ratios are blind to variations in accessibility within bordered areas.…”

Section: Reviewmentioning

confidence: 99%

Spatial accessibility of primary care: concepts, methods and challenges

2004

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Primary care is recognized as the most important form of healthcare for maintaining population health because it is relatively inexpensive, can be more easily delivered than specialty and inpatient care, and if properly distributed it is most effective in preventing disease progression on a large scale. Recent advances in the field of health geography have greatly improved our understanding of the role played by geographic distribution of health services in population health maintenance. However, most of this knowledge has accrued for hospital and specialty services and services in rural areas. Much less is known about the effect of distance to and supply of primary care on primary care utilization, particularly in the U.S.For several reasons the shortage of information is particularly acute for urban areas, where the majority of people live. First, explicit definitions and conceptualizations of healthcare access have not been widely used to guide research. An additional barrier to progress has been an overwhelming concern about affordability of care, which has garnered the majority of attention and research resources. Also, the most popular measures of spatial accessibility to care – travel impedance to nearest provider and supply level within bordered areas – lose validity in congested urban areas. Better measures are needed. Fortunately, some advances are occurring on the methodological front. These can improve our knowledge of all types of healthcare geography in all settings, including primary care in urban areas.This paper explains basic concepts and measurements of access, provides some historical background, outlines the major questions concerning geographic accessibility of primary care, describes recent developments in GIS and spatial analysis, and presents examples of promising work.

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Section: Reviewmentioning

confidence: 99%

Spatial accessibility of primary care: concepts, methods and challenges

2004

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“…HbA 1c was measured by high-pressure liquid chromatography (National Institutes of Health, 2001). Glucose measures and tolerance tests were rigorously collected for the SHS and SHFS; the procedures are described elsewhere (Connor, Kralewski & Hillson, 1994). …”

Section: Methodsmentioning

confidence: 99%

Access to Care and Diabetes Management Among Older American Indians With Type 2 Diabetes

et al. 2016

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Objective Examine the relationship between healthcare access and diabetes management among a geographically diverse sample of American Indians (AIs) age 50 and older with type 2 diabetes. Method We examined the relationship between access to care and diabetes management, as measured by HbA1c values, using 1998–99 data from the Strong Heart Family Study. A series of bivariate and multivariate linear models examined the relationships between nine access-related variables and HbA1c values. Results In bivariate analyses, out-of-pocket costs were inversely associated with lower HbA1c levels. No other access-related characteristics were significantly associated with diabetes management in bivariate or in multivariate models. Discussion Access-related barriers were not associated with worse diabetes management in multivariate analyses. The study concludes with implications for clinicians working with AI populations to enhance opportunities for diabetes management.

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“…al. [10]. Studies with a spatial dimension have either focused on potential availability or revealed availability in an area, see Shannon and Dever [11] and Gesler [12].…”

Section: Methodsmentioning

confidence: 99%

Patient allocations in general practice in case of patients' preferences for gender of doctor and their unavailability

et al. 2011

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BackgroundIn some countries every citizen has the right to obtain a designated general practitioner. However, each individual may have preferences that cannot be fulfilled due to shortages of some kind. The questions raised in this paper are: To what extent can we expect that preferences are fulfilled when the patients "compete" for entry on the lists of practitioners? What changes can we expect under changing conditions? A particular issue explored in the paper is when the majority of women prefer a female doctor and there is a shortage of female doctors.FindingsThe analysis is done on the macro level by the so called gravity model and on the micro level by recent theories of benefit efficient population behaviour, partly developed by two of the authors. A major finding is that the number of patients wanting a doctor of the underrepresented gender is less important than the strength of their preferences as determining factor for the benefit efficient allocation.ConclusionsWe were able to generate valuable insights to the questions asked and to the dynamics of benefit efficient allocations. The approach is quite general and can be applied in a variety of contexts.

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Measuring Geographic Access to Health Care in Rural Areas

Cited by 29 publications

References 56 publications

Spatial accessibility of primary care: concepts, methods and challenges

Spatial accessibility of primary care: concepts, methods and challenges

Access to Care and Diabetes Management Among Older American Indians With Type 2 Diabetes

Patient allocations in general practice in case of patients' preferences for gender of doctor and their unavailability

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